Casos

No more than the P-loop to make the diagnosis: which is the diagnosis?

Dr. Andrés R. Pérez Riera
Brazil

Case presentation

Female, Caucasian female patient, 58 years old. She has been known for a long time to be a simplex type of dextrocardia (normal heart with mirror image without other associated heart diseases). Situs inversus: the organs of the abdomen and lungs located in mirror image.
At the age of 10, a rheumatic fever outbreak occurred after Lancefield’s beta-hemolytic group A streptococcus aureus, leaving a severe sequel to the mitral valve (double mitral lesion of stenosis type), which forced the patient to undergo a valve replacement after 25 years (a bioprosthesis was implanted) Currently asymptomatic. No medication.

He had Blood pressure 130 mmHg x 80 mmHg, heart rate (HR) of 60 bpm, ictus or the maximum cardiac impulse at the intersection of the 4th and 5th right intercostal space in the right hemi clavicular line(on the right chest), regular heart rhythm and mild hypophonesis of the sounds. Heart sounds were heard on the right precordium and attenuated on the left.
We preform ECG ( ECG-1), VCG, a second ECG-tracing with right precordial leads (ECG-2) and Chest x-ray in the poster anterior and lateral view.